Provider Demographics
NPI:1992575203
Name:PERKINS-JANICEK PSYCHIATRIC GROUP, PLLC
Entity type:Organization
Organization Name:PERKINS-JANICEK PSYCHIATRIC GROUP, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:APRN/CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:TIDWELL
Authorized Official - Last Name:JANICEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-239-1404
Mailing Address - Street 1:327 CALDWELL DR STE 500
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3410
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:120 TWO MILE PIKE
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-1832
Practice Address - Country:US
Practice Address - Phone:615-239-1404
Practice Address - Fax:615-900-2716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-08
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty